Ep12: Solving Simple Problems for Big Impact: Dr. Robert Berke's Story As An Adaptive Entrepreneur in Public Health (Part 1)

Celeste Berke [00:00:01]:

Hello. Hello. We are here on the Sales Edge Podcast. This is Celeste, your host, and I am here with someone who, when you all listen to this, may think, what the heck does this have to do with sales? But I am about to dive in, and our guest today. We will draw some parallels into sales. It is none other than my father, Robert Berke. So I'm sure I will miss a couple of things, and he can fill us in here in a moment. But he is a just celebrated 41 years in business as a small business owner owner well into the 7, maybe eight figure business.

Celeste Berke [00:00:43]:

So he can talk to us about that. Has an MD, an MBA an MD from McGill, MPH from Harvard, an MBA from some some other place. It'll come to me. As well as a host of other accolades, including being an acupuncturist, has attempted 6 Ironman in the last 18 years, and completed 2. Whole another episode we can devote just to Ironman. But this is my dad, father of 4, still working almost full time as well as teaching spin class as well as other things. So we will get into it. Lived in Africa for 3 years, and worked for the Canadian government.

Celeste Berke [00:01:24]:

It goes on and on. What did I miss?

Dr. Robert Berke [00:01:28]:

25 years as a county health commissioner here in the county, went through some rather interesting events there. Yeah. There's a lot a lot a lot packed in there that could be unpacked over a long period of time. One of the things, you know, when you talk about business, they don't train doctors very well in because we our training is, you know, there's a whole lot of other things going on, and I think very little time is spent, and was spent when I was going through it. None was spent talking about the year gonna go out and, run a practice which is actually a business. You think you're just going out and treating people, you know, and you get paid and that's that's not the way it works. You have staff, you have a a facility, you have supplies, you have All kinds of things. Unfortunately in the United States you have this absolutely crazy billing system with multiple payers and all their Rules and regulations.

Dr. Robert Berke [00:02:26]:

It's really a a very complex business. In Canada it was a lot easier, one payer, and actually, you know, that was pretty simple. But even then it was a business and so when I kind of started out I didn't have much business experience. Fortunately, I didn't have to. I went to Africa and I was working for the Canadian government as a public health officer Running a very large operation which I had no experience in and had to learn on my feet. And basically after The person I was replacing left with giving me a little hands on experience, there were a lot of stuff to learn. And what I I found was Which was just something that I found out that I was kind of an adaptive entrepreneur. I I I kinda started figuring out and seeing things that weren't working well in the business we were in which host, providing public health to a 1000000 people with a budget of a dollar per person per year.

Dr. Robert Berke [00:03:25]:

And you have to figure out how to use that, which is business, mode so that you got the best bang for your buck, which is business in a sense. One of the most interesting things was I was The chief of service for one of the provinces of Cameroon, the northwest province, and I would go to these meetings and listen to the other chiefs of service talking about how they weren't getting anything done because their vehicles were always broken down. And it's very interesting because we had a hodgepodge of vehicles, Some gifts from the Canadian government, some from, UNICEF. They're all different. 3 Land Rovers, 2 Volkswagen buses, Renault Jeep, but, you know, whatever. And And I immediately realized our life blood was these vehicles because we had a huge territory and a lot of our work was going out on dirt roads. 45 clicks are 45 kilometers, you know, to a health center for our staff to run an immunization clinic, whatever it was. And I realized listening to these stories and knowing what kind of brutal conditions were there were for the roads and and on these vehicles, that We had to do something different and we had 2 drivers who were mechanics and I thought, you know, we got 2 mechanics.

Dr. Robert Berke [00:04:42]:

Why don't we just dig a hole and rather than we had no lift, so we dug a a pit And rolled the vehicle, you know, got a little built a little kind of affair that protected the, you know, just a tin roof and I drive in over the pit And we changed our oil, rotated our tires. Never we lost 15 minutes of of we had 15 minutes of downtime in 3 years on our vehicles because vehicle maintenance. I never owned I hadn't owned a vehicle to that point, but I realized That could. It's in Montreal. Walked to work, and I didn't need a vehicle. But I realized that that was our lifeblood. And if we didn't have that, we would be like the other characters I was dealing with at those meetings who had said and complained about the fact that they didn't have anything. Anyway, and then you know you start to look and then we were running.

Dr. Robert Berke [00:05:31]:

My my predecessor had started small dispensaries in our health centers because people couldn't afford medication home. And the local pharmacies. It was impossible. No one could afford it. So I looked at it and said, but we've got 27 of these these maternities and delivering babies and seeing kids and 2 dispensaries. Why don't we open our own pharmacy, so to speak, and have them in every one? So we over 2 years did that and We did it on a cost plus basis so that we just earned enough per malaria medication or whatever it was To pay for us getting more. We weren't trying to run a profit. We were just trying to cover our transportation costs.

Dr. Robert Berke [00:06:14]:

So the price was like very affordable for people. And we were and it was so it was so affordable that actually I had one of the The missionary doctors at a local hospital who used to make their money on selling them tell me that I was ruining his business, you know, because we we were doing this and we were getting what we needed to our, you know, our residents out there at a very, very low cost. And it was a very complex business because we were Supplying pharmaceuticals. Now, my dad was a pharmacist but it didn't help me at all. I mean, this was a totally different operation. Made some mistakes, Had a guy stealing, you know, you have all kinds of things going on there. But in general, when I left, the World Health Organization copied that for a province in Nigeria and one of the guys who had been working with me was involved with them. And he had this novel idea of just low cost, Low profit margin.

Dr. Robert Berke [00:07:12]:

Just, you know again, just figuring it out how how to do it. So when I came

Celeste Berke [00:07:18]:

Well, this adaptive entrepreneurship. Right? So you're in this place. You're 23?

Dr. Robert Berke [00:07:26]:

No. I was, like, 25, 26, 27 maybe.

Celeste Berke [00:07:29]:

Yeah. 26, 27 years old, having learned

Dr. Robert Berke [00:07:32]:

Never run a business in my life. Never, home You know, like, I I worked summers, you know, teaching swimming at a summer camp or, you know, whatever. I I

Celeste Berke [00:07:40]:

never Right.

Dr. Robert Berke [00:07:41]:

You know?

Celeste Berke [00:07:41]:

But you also deal with what a lot of us deal with in sales, which product aside, right, whatever the Canadian government's intentions were, you run up against the buyer, we'll say, the individuals with Mhmm. Who live there. Right? The people of Cameroon, who this is how they've done it for however long. They've got the goiters and all of the worms in their eyes, all of these issues. Why make a change? So talk to us about because there's this whole, like, change management process or change influence. How were you able to come in and say, we wanna partner with you and make all these changes because of x y z.

Dr. Robert Berke [00:08:24]:

Oh well, I I I had the good fortune of having a very large staff of local folks who knew the local arrangement and we weren't, You know, we weren't doing brain surgery, we were just making sure that babies got delivered safely in our, home. We have maternities in 27 little communities, and we wanted to make sure babies got and women want to have a home delivery. That wasn't a big sell. Okay?

Celeste Berke [00:08:53]:

Well, I'm assuming was there a high, infant mortality rate?

Dr. Robert Berke [00:08:57]:

Mortality rate? Of course. Those countries have very high infant mortality rates Because of death in the 1st year of life, which is all of the story which we'll get to. But basically, there was another issue. You, when you had your your little girl, you know, went into labor and drove to the hospital and, you know, had a baby, you know, after a little while. Well, a lot of these women are walking 15 or 20 miles from outlying communities which this health center that we had served. The midwives were excellent. They were all trained and could deliver, they delivered a lot of babies, but you're having women. So we decided, you know, this is not a great idea.

Dr. Robert Berke [00:09:37]:

Why don't we build some rudimentary structures near the health host. Where the women could come maybe a couple of days before we ex you know, they think they're due and they would they would be very close to what they lived in, You know, in their villages and we wouldn't have babies being born on the the way in and we wouldn't have babies being born in. And so all of our health centers built the we had health committees who built these, you know, very rudimentary structures where women could come early and have a bed, And also cook and then wait and then go into the maternity, have a safe delivery, and then go home. And again, just Yeah. Figuring out what, you know, the simple things you need to do to get a better outcome in a situation where for years, it was, you know, it was what it was. We had the maternity there, they were all clean, they were all you could smell the disinfectant, I mean it was, We made sure and those, you know, it was amazing how very, very proper those places were, much different than What these women delivered in in their villages, but that wasn't the problem. The problem was They had to get there and so we figured and there was no transportation. They're walking on paths, you know, through, high grassland because we lived in a high grassland area, Savannah.

Dr. Robert Berke [00:11:01]:

But still, they're walking, you know, who knows how how far. And so that was another issue. Then of course, there's the issue of their kids. No one wants their kids to die. Convincing them to get an immunization was not difficult. Getting them to have an immunization, you know, so we had to figure out ways to to get the immunizations out to them and it was all just, You know, you're talking about what I do now and what was done there on the sell. I'm telling you, selling someone now To get a COVID vaccine is a lot more difficult than talking to one of those folks in Cameroon to get their kids vaccinated so they don't die of measles or whooping cough or polio or whatever else. They were dying of tetanus, whatever else, and I've seen it all.

Dr. Robert Berke [00:11:51]:

You know, rabies, all these things.

Celeste Berke [00:11:54]:

And, Cameron, you probably had so as sellers and and you have this yourself. We've talked about it, right, on on your buying committee. It's yourself, the, you know, the owner, the partners, sometimes the practice manager. Right leg decisions are no longer made by 1. It's usually a committee committee decision. Whereas in Cameroon, probably the influence of, I'm assuming, those vaccinations vaccinations, and changing that outcome is getting an evangelist. Right? Someone who truly understands, also speaks the language, knows the culture, who's then infiltrating these small pockets to really become this evangelist of, hey, everybody. Let's get on board to do this, and then you get another evangelist and another and another and

Dr. Robert Berke [00:12:39]:

home We got around that by creating health committees in each. And you're finding some locals in each community village who were interested in, you know, improving things and which meant water supplies meant latrines meant, you know, all kinds of things. And they were instrumental in putting the message out, but it was my job as the, you know, The the big kahuna, so to speak, to go, you know, walk come in there and I walked into some of those places a couple of times a year, you know, and I would visit all my health centers on a monthly basis just to meet with the health committees to try and give them Very rudimentary understanding of why these things were being done, why, you know, you You know, there is a very interesting expression in in English, which I won't get to, but you don't crap where you eat. You know? Well, there it was Yep. You've gotta deal with human waste because it contaminates the water which creates the diarrheal disease which kills your kid before they're 1 year old. And so we had a huge process of these committees digging community latrines, you know, incredible. You know, 20 feet deep, 3 feet wide, 6 feet long, covered over, dot dot, you know, the whole I mean, little Yeah. You know? These were Yeah.

Dr. Robert Berke [00:14:04]:

Very simple.

Celeste Berke [00:14:05]:

We talk about it a lot in the sense of, right, there's there's a business problem. So in this sense, off the top of my head, it's like health in safety. It's like you you can't fix it immediately. Right? It's a Mhmm. Epidemic. It is the health and safety of a community, and then you have the impacts. Right. The death.

Celeste Berke [00:14:21]:

You have the the numbers, right, the impacts to the family, what's happening. But then you also have this root cause, which is what? Your your team was working in all of these 3 buckets. Right? But as salespeople, all we are is, like, well, if we can just come in and Fix This One Thing. It's going to fix everything else. Well, it yes. Fixing the water supply, but also then you've got, you know, the immunizations and all that, like, all come together in order to fix this big problem.

Dr. Robert Berke [00:14:46]:

Of course. But, you know, I see in my, In my work now, I see a lot of physicians who travel overseas to those places and Work for 3 weeks in some hospital fixing hernias or doing this or doing that. The reality is they They feel good when they come home. Okay? And they've helped 20 people, you know. When you look at the problem when I was there, and we'll get away from this Because I'm just using it as an example of how I approach things. You're looking at massive problems that have very simple solutions That require, understanding the root problem and getting at it. Sure. Fixing someone's goiter is marvelous, you know, for that 1 person.

Dr. Robert Berke [00:15:40]:

Fixing the water supply for a village or a community Is is is incredibly, impactful. And I can tell you that our little hospital was empty when I left of cases of whooping cough and measles and polio and everything because we Had a very simple solution, get to the people who needed what they needed and get what we and it was it was but again, it was a business solution at looking at what we needed to do to get to the root cause of what was going on and what was the real problem. The the, most obvious problems you could fix, but you would fix them 1 at a time. The root problems, you could make a huge difference in the life of that community or from a business sense in in how, the outcomes looked. And so That was a tremendous lesson for me because when I came back to the United States, I went to, you know, the school of public health for a year, but then I went into private practice Which is business and my partner and I had to run a business. We had to buy I have a facility. We bought 2 actually and ran 2 practice, had to employ staff. And, oh, there's a learning process there and The mistakes you make and the things you learn and fascinating.

Dr. Robert Berke [00:17:03]:

Fascinating.

Celeste Berke [00:17:04]:

So you went quick story. You were living in Canada, 80 acre farm, doctor by day, farmer by night and weekends, started your family, moved to the States

Dr. Robert Berke [00:17:20]:

Yeah.

Celeste Berke [00:17:20]:

40

Dr. Robert Berke [00:17:21]:

years ago. Quebec was trying to separate and my partner left and home. Left me with the whole practice and 2 2 offices and whatever else, it wasn't gonna happen and so we basically, At the time, if you were selling, you were selling into a buyer's market, not a seller's market, and we left with almost nothing. You know, 3 kids, 1 6 6 week old, you and your sister who are 5 4 5 or something like that. I

Celeste Berke [00:17:48]:

was 2. I was 2.

Dr. Robert Berke [00:17:51]:

82. You were born in 79. You were 3.

Celeste Berke [00:17:53]:

3.

Dr. Robert Berke [00:17:54]:

Almost 3. Okay. It didn't matter. You were 2 going on 15 anyway at the time, if I remember correctly. But I came here and I had a job. I I I I was to be the, health commissioner for the county. So I had a salary, but I wanted to open a a private practice. But again, had to start all over again with, you know, No way in in in we we had not much money coming here because we'd given everything away just for to cover the costs of or the mortgage or what was left and it came with, yeah, $10,000 or something like that.

Dr. Robert Berke [00:18:28]:

Anyway, but we didn't owe anything and I just started up. But it was 5 years working all by myself, delivering a 100 babies a year, working, you know, 7 days a week. No. It wasn't all 7 days a week. I still got out and ran, and I still had all my kids went to their games and did everything, but still It was I I was busy, but I I built a small business, took on a partner for another 5 years or 10 years, I Forget. And then he left, took on another partner, then then we were in business. Then we decided we're we're gonna expand because

Celeste Berke [00:19:06]:

Hold on one second. Because I always ask the guest, and, we haven't gotten into that yet. This is a different, a little bit of a different episode. It's not a not a short. This is gonna be a 2 parter. So I wanna talk about the first hushing in in this because I think it goes into what you just said. So those 1st 5 years and something I've always admired about you and you and I talk about it. Definitely a couple times a week is this concept of your mindset and where to focus and, like, how to stay in your swim lane.

Celeste Berke [00:19:40]:

So talk to me about, a, where you learned this practice of betting on yourself, but also this, like, edge, your sales edge of, like, having this mindset that is, for the most part, like, unshakable. Coming here and there right around Ironman time. It gets a little dicey, but

Dr. Robert Berke [00:20:00]:

Yeah. Yeah. For sure. Well, there are a couple of things. One is I was very fortunate in in one sense. I started practicing medicine in Canada And that that was very unfortunate experience because I can remember, and this is one of those seminal memories I remember, I walked out in my waiting room in this office in Knowlton, Quebec. And sitting in the waiting room was were 2 women side by side chatting, you know. 1 worked at the local Clairol plant earning $7.50 an hour, house.

Dr. Robert Berke [00:20:39]:

And when was the wife of the CEO of Bombardier, you know, Ski Doo Snowmobile. They make airplanes. They make subway cars. They they make things that Make them very wealthy. And they owned a very, very, very, very nice place just outside of town. But they both had a little blue card in their hand, which was their ticket to get in to see me. And that was it. I had no need to as to who is paying me whatever else.

Dr. Robert Berke [00:21:07]:

There was a single payer source. So when I moved here, I had no concept of that. And so when I started, I would see everybody. And a lot of the docs wouldn't see the Medicaid, you know, the ones that and I remember I delivered, oh, I don't know how many babies Where we were getting paid, you know, very little to for the no one would touch them. But from my background was you That's not what you do with people. Well, the world has a funny way of coming back to to look after you because at a certain point, Suddenly the reimbursement per delivery went from $2.50 to $1600 a delivery. It was nothing that I had banked on or thought about. I was just doing what I was doing and suddenly those people who I had Given service to who knew that they were being told that they, you know, they weren't good enough to go somewhere else or whatever else, We're my patients.

Dr. Robert Berke [00:22:08]:

And I had built a very large, you know, practice, you know, fine, I mean, I I don't remember what I was earning, it didn't matter. We never you never missed a meal. You never went for, you know, missing for anything. And maybe our vacations house. Shorter and then we didn't go yeah. But but we anyway.

Celeste Berke [00:22:27]:

No. I mean, we lived modestly.

Dr. Robert Berke [00:22:30]:

Yes. But but That's the way it was. But basically I had built this rather large practice and I think the reputation also was we saw everybody I looked after everybody. And the moral compass, you know, drove the whole thing. And the hard work, you know, I get called at 2 the morning to go deliver a baby, and I was gonna get paid peanuts for. It didn't matter. That was my job, and that's what I did. And and the patients really appreciated it, and that was the service I was offering.

Dr. Robert Berke [00:22:58]:

And I did it with a smile, and it was, you know, it was just one of those things. And they're still my patients now many years later, and the kids are my patients.

Celeste Berke [00:23:06]:

And But you have the lesson of this, like, mindset of even when it's tough. Right? Not missing workouts. Even still, 5th 50 years later, how where does that stem from of not letting the Don't know. The outside forces infiltrate here.

Dr. Robert Berke [00:23:26]:

Don't know. I don't know. It just there were there were a couple of things that that drove part of it. And I I I've always liked exercise. You know, I was a college athlete and afterwards I ran and, you know, I ran 5 marathons. I skied, you know, ski marathon. I mean, I just I like the I wasn't fast. I wasn't winning in my age group.

Dr. Robert Berke [00:23:48]:

I just was out there doing it because it was healthy. And the other thing was I knew that if I walked into the office weighing 300 pounds smelling a cigarette smoke and tried to talk to someone about not smoking and, you know, staying healthy, it doesn't work. And so I I always knew you had to live, You know the story if you were going to do it and going to teach it and not For any other reason, but that's the example you have to set when you're in this business. That was just my mindset. Now, Am I a little bit nutso about exercise? I don't I don't think so. I just like what how I feel when I exercise every day. First of all, It's fairly stressful listening to 20 or 30 people in a day unload on you, you know, about, you know, whatever they've got. Some of them just for coming in for a physical but some with some significant issues including having to tell them they've got a serious illness or that they need some interventions or they need to change their lifestyle.

Dr. Robert Berke [00:24:56]:

And I've always found that having a bit of exercise Usually early in the day if you were can remember me at the year making the peanut butter sandwiches when you guys woke up and I had already run 6 miles, it was because, a, that was the only time of day when I knew I had some time, and b, it set me up for the rest of the day to be, It took a little edge off. You know? I I was I had a little endorphin buzz. I felt a little more relaxed people. I didn't get as irritable as you can get when you're tired and, you know, and sometimes I I Come home after delivering a baby at 3 in the morning and know that I was gonna be up in an hour and a half or 2 hours so I go for a run. And by 6 or 7 at night, it was a long day, but still, I sometimes have to get up that night and do it again. But There's a certain discipline in in in my life, which is getting some exercise every day. I swim today, by the way. My group, you know? You know, I I'm just saying, it's like it's

Celeste Berke [00:25:58]:

just 1 moment. Years old. We're still exercising on the daily. Although you're you're coming down from your latest Ironman. Yeah.

Dr. Robert Berke [00:26:07]:

Ironman. And then COVID about a week a month later. Yeah. That that was that was tough. Yeah. Anyway.

Celeste Berke [00:26:13]:

You see problems every day. In in the sales world, many people talk about their product. Right? So back in the heyday of drug reps coming in, pharmaceutical reps coming in, talking all about their products, whatnot. I mean, you've seen it, all of the product pitching. And there's a slew of sales advice out there, and we can get to all the advice because you see it as well. But I think there's a lot of parallels here. You know, there's sales advice out there that People are still practicing pitching their product and putting their agenda on you. And then there's those of us that are seeking problems.

Celeste Berke [00:26:48]:

Are there problems that I can solve here? And I'd love to know as a practitioner, every day you hear so many problems. How are you weeding through to figure out, a, what's most important? Is this person full of BS? And, also, how are you going to influence or help them see that they have to change

Dr. Robert Berke [00:27:11]:

Yeah. Before

Celeste Berke [00:27:12]:

some really bad stuff happens.

Dr. Robert Berke [00:27:14]:

Well, first of all, let's talk about the drug reps for a minute because They come in, you know, and pitch their stuff, and some of them are pitching at you a me too, and it's already 3 or 4 iterations that we've heard from other companies. Home. And I feel bad for them because it's it's a tough job. And but we've gotten to the point now they come in and they just They just bring us live and we chat about we chat about their kids and everything else because they know they don't have to you know? And they leave us some samples then go away because it's, Yeah. That whole it it almost irksome when they come in and start pitching at you, hey, hey, I just want 1 prescription out of you. Can you just try it while, you know, like, give me a break. You know, the it's the old hard sell kind of stuff.

Celeste Berke [00:27:58]:

Watch Watch Painkillers for anybody out there. You'll see exactly. It makes sense.

Dr. Robert Berke [00:28:02]:

Yeah, I know. It's it's just but anyway, talking about What I have to deal with is where you're going, where I get a patient coming in and there's a couple of one is sometimes They need a lifestyle change. Those are the hardest because you're you're looking at ingrained issues that have not gone on just for a day or home. You know, smoking. They've been smoking for 30 years. Or or they're looking at a history of if they keep smoking, it's gonna be 30 or 40 years before they give it up. At which point, they're gonna have some significant problems. None of which they have now.

Dr. Robert Berke [00:28:40]:

And so they can't understand why you're chatting about it except you have a dataset that's like from 1960 on of why they should stop. Then you have the other stuff which is a little bit more difficult, And that is the preventive care that you have to encourage people to get. Women, you know, mammograms, pap smears, here. And then you start talking about, ew, colonoscopies, you know, and and and to try and convince people to do those. And then, of course, now with our dear friend COVID around immunizations and the newer iterations of flu vaccine and RSV vaccine and all of this stuff, And they're onto the internet and Facebook and all the craziness out there, and you're you're having to spend all the time Trying to undo really bad information that people are getting to get them to understand why it's important for them. That's very difficult. And there are strategies that you have to use, some of which are easy. If you've got a patient who trusts you it's very easy.

Dr. Robert Berke [00:29:44]:

They just come in and say, hey, I I've heard about this new vaccine. Do you think I should do it? And you talk with them about it and they're fine. You know, because it's a long standing relationship. Here. But then you got people who come in and they are not gonna they don't want any part of this. And they're the toughest because you spend a lot of time with them and a lot of them you don't get to go with them. And the strategies vary from just saying, hey, you know, go ahead. Do what you wanna do.

Dr. Robert Berke [00:30:10]:

I'm telling you A 1000000 people died of COVID over the last year and a half in the United States. You've got some risk factors. I think you're making a big mistake, but You can't do anything about it because they saw on the Internet and da da da da. You know? And and it's impossible. And then you have the other People who you can convince with some strategies. I have one which I love to use and and I'll explain this to you. You know, we have now 33, Four possible issues with colonoscopy. First of all, colonoscopy is life saving.

Dr. Robert Berke [00:30:43]:

It's life saving if if if, you know, used appropriately.

Celeste Berke [00:30:47]:

A little p a little PSA. The age was moved up from 50 to 45.

Dr. Robert Berke [00:30:52]:

That's right. Because we're seeing younger and younger people with colon cancer.

Celeste Berke [00:30:56]:

I'm really excited because my husband turns 45 before I do, and I can't wait for him to go through that before me this coming

Dr. Robert Berke [00:31:06]:

year. Yes. But do you know what? It's lifesaving, and it's the only test we can do That gives you 7 years. It tells you literally you don't have to worry for 7 years. You know, we were doing PAP smears on women every year which is a waste of time, but Anyway, now it's every 3 years or 5 years depending on your HPV positive or not. But we didn't know but this is 7 years. And then we have Cologuard, you can get it in a box the mail, you poop and it's sending it's good for 3 years. Or we can give you a fit kit and you wipe a little poop on it, it's good for a year.

Dr. Robert Berke [00:31:36]:

People won't do it. They just don't wanna do it because it's poop, you know, and so no matter what you do, you can't convince them to do it. So I figured out a strategy. I bring a little sandwich baggy in, and I say, you wanna wear one of these on your side, you know, for the rest of your life? That's what happens if you have a colonoscopy. You have this sandwich baggy on you. Oh boy, I I have convinced a whole bunch of people. But again, you have to figure out ways To get people to go because you're trying to get people to do things that they really don't want to do even though it's in their best interest, and that's a very hard sell. Now in in in a business sense, it's important for us to do that, by the way.

Dr. Robert Berke [00:32:20]:

That's the other side of this which People don't realize most doctors are involved in risk sharing arrangements when If you have a a a pool of people, let's say men and women over 50, should have colonoscopies. Well, if you attain a certain percentage, the insurers have a kicker for you. I I'm talking serious kicker. You know? Like, Real money. And, the same thing with diabetics, if they get their, you can enhance your your your revenues, which are important because they pay the staff, they pay your salary, whatever else, by about, 15 to 20%. So it's really important to get that message across. Home. From a business point of view it's important, but also deep down these measures are Right.

Dr. Robert Berke [00:33:12]:

They're the standard Yep. You know, states public health service and national guidelines which are important for people to do. It's not they're so important that They're incentivizing us to incentivize our patients. It was so it is so lucrative for doctors to do this That we were actually giving patients

Celeste Berke [00:33:36]:

Gift cards. Right?

Dr. Robert Berke [00:33:38]:

Gift cards to happy. To go and have this done. Yeah. Why not? Right. I mean, it's we you're you're incentivizing them to do it, which for you, there's an incentive, but also it's In their best interest.

Celeste Berke [00:33:50]:

Right. There's no negative if if you see if you save a life from early detection from a colonoscopy, you can look at yourself in the mirror that night, versus selling someone a vehicle they don't need just to line your own pockets. Like, there's a

Dr. Robert Berke [00:34:04]:

Of course. Of course. But I don't know how many I mean, a lot of the insurers have gift cards as well. Even with those, it's hard to get people to go. You know? It's It's

Celeste Berke [00:34:14]:

Well, it's the same it's the same thing in business. You're trying to change I mean, for you, it's individuals, but you also have the team. It's trying to change a culture often that a product is going to change. You're trying to change behavior. We've always I mean, how many times did I tell you in my former career? Like, we've always done it this way. And I'm like, yeah. There's so much revenue opportunity or whatnot. It's just like, no.

Celeste Berke [00:34:39]:

Because change is hard as humans, and now you add in that personal factor, and it becomes like, oh, that doesn't apply to me. I don't wanna do it. It's too hard.

Dr. Robert Berke [00:34:51]:

Well, on another on another basis, in 1999 I had some cowboy come to me and say, you know, we've got this computer program you could use in your office, you know. And I looked at it and it was really not very good. And I saw that there was a a conference in New York City on computers and medicine. And I I knew that this was, you know, coming but I because it was all paper and we had gone from paper to We were dictating our notes and someone was, speaking of business, we went from handwriting our notes, which was just brain dead

Celeste Berke [00:35:31]:

because nobody can read your notes,

Dr. Robert Berke [00:35:33]:

yes? That's right. To dictating our notes, having someone type them, send them back on sticky sheets, we would stick them in the chart. High costing us $40,000 a year, but it was time for us, you know, so it well, I went to this

Celeste Berke [00:35:48]:

Well, hold on. Let's. I think this is a good seed for episode number 2. Let's talk about the transition of technology in medicine and someone trying to sell you a tech solution. And what happened because I feel like I was part of this journey as well I busted my face open and had to get stitches at your office during all this. So stay tuned if you're listening. Join us for part 2, lessons in life sales and medicine with doctor Robert Berke.